Wednesday, March 4, 2015

Using the Health Reform Template on Ukraine

Many decades ago, the teenage father of the Disease Management Care Blog personally witnessed the Russian invasion of a smaller bordering country. If he were alive today, the DMCB dad would scoff at Mr. Obama's assertion that the Russians are "on the wrong side of history."

Rather, they are being entirely consistent with their history.

Yet, the healthcare-minded DMCB can't help but see several parallels between the geopolitical situation in Ukraine and the health-reform situation in the United States. While the DMCB dad would have advised hoarding gold gasoline and gunpowder, the DMCB would like to be far more constructive.  It points out to Mr. Obama that there are some ACA-like options that can help with this Kiev kerfuffle.

 And even if none of these actions help, they'll at least give that appearance:

Since Mr. Putin is acting like a bully, treat him the same disdain you've shown to many of the commercial insurance company CEOs. While, just like those CEOs, he is unlikely to be cowed, the political base will still love it.

Just like the ACA, it's OK to publicly set and then disregard hard conditions and firm deadlines on Ukraine. Mr. Putin (unlike your Republican opponents, by the way) won't take them seriously either, which ironically gives you the flexibility to likewise adapt as other short-term considerations arise.

Instead of the hard work of doing one thing well, create a flurry of initiatives. Recall that what the U.S. really needed a was a fix for the individual insurance market. Instead, it got so much more, including payment reforms, mandates, minimum benefit language, caps on administrative costs. ACOs, insurance exchanges and lots of lawsuits. While Ukraine needs the Russians out of Crimea, a similar approach calls for lots of G8 actions, U.N. resolutions, I.M.F. interventions, economic sanctions and Kerry speeches.

Speaking of the United Nations and the International Monetary Fund, it's OK to outsource much of the heavy lifting outside of the White House. Just as you tasked Congress with writing the ACA, think about letting the European Union take the lead, starting with a courageously worded condemnation of the carbon footprint of all those Russian tanks.

Finally, if things get uncomfortable don't hesitate to use the power of the bully pulpit to change the topic. Options include immigration reform, income inequality among your donors, extending early childhood education to newborns and promoting frozen yogurt as an alternative energy source.

Coda:  The DMCB missed a key parallel involving the reliance on lawyers.  Health reform and Ukraine have less to do with patients or civilians, but attorneys and jurisprudence.

In the category of "you can't make this stuff up," after this post appeared, the March 5 Wall Street Journal quoted Mr. Obama as saying, in reference to international law, " I know President Putin seems to have a different set of lawyers making a different set of interpretations, but I don't think that's fooling anybody."

No comments:

Post a Comment

Note: Only a member of this blog may post a comment.